Integrating assistive technology in affordable housing for people with autism and other disabilities

Assistive technology is very much a "seeing is believing" phenomenon that requires hands-on experience in order to educate families and people with disabilities as to what is possible. There is a broad range of extant technology devices and systems with the potential to improve quality of life for caregivers as well as those receiving supported living services. These can be very low tech items such as a table-mountable nail clipper, switch-operated light, or adaptive gardening tool to aid individuals with limited dexterity. The higher tech range can include speech generating devices and smart home technology involving sensor-based environmental monitoring and remote care giving. Many of these items are very low or moderate in cost while a few are more expensive. However, apart from cost, a key barrier to more widespread use of assistive technology in general involves a lack of awareness on the part of consumers as to what is out there and how it can support independence and care giving.

This page is under construction and over time, we will offer many examples of helpful assistive technology.  To begin to become familiar with this topic, See this very informative PowerPoint presentation called Integrating Assistive Technology into Affordable Housing for Seniors and People with Disabilities by Tom Keating and Gerald Stolp: http://www.technologyforhousing.org/Project/project-Powerpoint.ppt

Tom Keating grew up in the Bronx, NY, and has lived for over thirty years in Eugene, Oregon, where he is Director of Eugene Research Institute a non-profit organization engaged in assistive technology research and development. His work focuses on cognitively accessible computing and design of systems for community living support, including creation of the Picture Planner™ icon-based personal organizer. Since 1981, Tom has been the primary caregiver for his brother James, who has autism, and this experience has been a crucial influence in shaping his technology development work and his understanding of disability. Tom is married and he and his wife, Janet, have twin seven-year-old boys who are the light of their lives.

Who Sings the Shower Song? Tom and James Keating Work it Out Using Assistive Technology in James’s Apartment

This is Tom’s story about his relationship with his brother James, and how he helped James to live independently with the help of innovative assistive technology.  Tom and James’s story can be found in a book called Thicker than Water: Essays by Adult Siblings of People with Disabilities. 

Examples of Technology Applications to Support Individuals’ Safety, Independence, and Quality of Life

Our definition of the universe of assistive technology applications is broad in the sense of encompassing environmental modification technologies such as those pioneered by George Braddock and Creative Housing Solutions as well as the kinds of assistive technology devices and hardware/software products that are typically perceived as fitting the definition. It is narrowed somewhat by the specific emphasis of this project on technology integrated with long term supports for housing that bears on enhanced safety, health, independence, and quality of life, including:

• Environmental control: Inexpensive equipment using the X-10 powerline standard is available to provide remote switched or voice control for more independent control of basic household functions such as HVAC, lighting, radio, TV, and small appliances such as coffee maker, fan, or massage device. These same controllers can be used to govern access to any plug-in device in the home, such as TV or radio, in the event that contingent or supervised access is desired.
• Unobtrusive monitoring for health, safety, and daily living skills support: Standard computer technology combined with X-10 modules can provide care providers with remote monitoring and video communication capability for use in dispersed supported living settings. With such technology, consumers can live in less restrictive settings while care providers and family members can receive updates to ensure that expected activities of daily living are occurring or, for example, that there is no unexpected or unusual night time activity. Such systems can also monitor smoke alarms and notify persons outside of the unit when they trigger, turn off appliances such as stoves that have been left on, provide safety lighting at night that is triggered by infrared motion sensors, or provide video communication to decrease isolation and guard against victimization for individuals living in less intensively supervised settings.
• Self-management: Combined with computer software for personal activity management, sensors can also provide support for increased self-sufficiency. For example, in a home without air conditioning, which is true of many older apartments and homes, a fan could be set to turn on when the temperature exceeds a certain point.  Or lighting and audio-visual equipment can be set to dim or go off at set times in concert with a preferred night time routine. There is also significant development effort underway for task-prompting and reminding systems to aid in the completion of household tasks and routines (e.g., Dasler, Mann, Witte, & Belchior, 2004).
• Communication: Household phones can be programmed with picture-based speed dialing, and flip-style cell phones can be set to dial just one number automatically when opened as a simple, immediate way to get help (Vanderheiden, 2004).  Two-way video communication via computer can help alleviate transitions and help to maintain relationships.
• Computer/information accessibility: Computing technology offers many options for enhancing housing for persons with disabilities so long as they have a means for adaptive access, such as switch, touch screen, hands free mouse, etc. Information accessibility has implications not only for better integration into the community, but for expanded community-based and home-based employment possibilities, and better communication with agencies, providers, and personal networks. Cell phone/PDA devices can also provide task-prompting and activity completion guidance, and Web-based reminder systems such as iPing.com, pcreminder.com, and others can also aid self-management.
• Miscellaneous AT products, methods, and services: Web sites such as http://www.abledata.com  or www.catea.org offer access to information through comprehensive databases on assistive technology products and adaptive equipment ranging from oversized remote controls to all-terrain wheelchairs, as well as tools to match consumer needs with products (Scherer, 2002), to identify audience-specific training resources, and links to information on AT resources, policies, research activities, and organizations.

These are some of the technologies that are currently available for practical implementation today. Other innovative developments will augment the cognitive and physical capability of individuals with disabilities and elders and expand their access to accessible and affordable housing of their choosing in less restrictive settings.  This approach is two-pronged:

• enable the practical implementation of currently available technology consistent with principles of universal design to ensure that supports carry maximum impact (Vanderheiden, 2004).
• ensure the development of proactive infrastructure support to respond to future developments.

A well-prepared infrastructure will be able to leverage such technologies to help Medicaid clients now living in congregate care settings to move to more integrated community living with help of unobtrusive monitoring and smart home technology. Others living in family homes or group homes may be able to have increased independence, with staff efforts focused less on simply “checking in” and more on community integration. Note also that the emerging client base on the high school transition end of the continuum will be increasingly comfortable with technology use, with higher expectations for its incorporation into housing and supports delivery systems.

Contact Tom Keating at the Eugene Research Institute to read these complete abstracts:

Picture Planner™: A Prototype Cognitively Accessible Personal Activity Scheduling Application

Picture Planner™

The project that evolved into Picture Planner arose out of several other software development projects designed to help individuals with disabilities live more productive, satisfying, and independent lives.
Picture Planner™ is an icon (picture) based scheduling system that assists individuals with disabilities in planning and viewing activities by individual activity, day, week, or month. Picture Planner uses synthesized speech to provide feedback and aid in accessibility.
Picture Planner is highly customizable -- you may import pictures from any source. Picture Planner also includes a stock library of images to help you get started. You can add new users and easily schedule group activities for multiple users. And you can easily move, copy, and schedule repeating activities, all with an icon-driven software interface.

ADL Assistant: Development of a Prototype Intelligent Remote Caregiving Application for Individuals with Cognitive Disabilities and Caregivers

ABSTRACT

Purpose: This paper describes prototype development and case study implementation evaluation of a feasible residential activity monitoring and prompting system for use by individuals with cognitive disabilities and their caregivers.

Methods: The prototype ADL Assistant combines a cognitively accessible activity planning application, residential sensor network, Web interface, and expert rules application to provide individuals with disabilities and caregivers with intelligent feedback on completion of activities and tasks within the home environment. A targeted single case study evaluation was conducted in the area of personal care task accomplishment

Results: We hypothesized that consumer self-management and caregiver support tools that incorporate expert systems would improve the ability of individuals with cognitive disabilities to self-manage in community living settings and improve the effectiveness of caregivers in supporting them. Results of the prototype evaluation confirmed that hypothesis, showing a clear increase in completion of goal activities based on system implementation, and underscoring the importance of real-time home activity information for caregivers.

Conclusions: Sensor technology in combination with intelligent software development
offers promise for the development of residential support and remote care giving tools that can enhance caregiver effectiveness and consumer self-management.